At a meeting of the Clinical Society of London in November 1883, Felix Semon drew attention to Kocher’s presentation at the German Surgical Society the previous April, and proposed that myxoedema, cachexia strumipriva and cretinism were all due to the same cause, namely, absence or degeneration of the thyroid (Semon 1883). At the time, Semon was a 34-year-old assistant physician for Diseases of the Throat at St Thomas’s Hospital, London (he would later be knighted as the doyen of British laryngology). According to Rolleston (1936) and Medvei (1993) his remarks ‘excited ridicule’. There is no suggestion of this in the British Medical Journal’s detailed transcription of the proceedings, nor in the exceedingly brief original written minutes of the meeting (an extended account must have been written up at some later point for the BMJ). Ridicule may not, of course, have been minuted. Semon in his autobiography says only that his ‘extremely bold assertion was received with polite scepticism’ (Semon and McIntyre 1926),though he writes of antagonism towards him in his early career. Nonetheless, his very astute idea of the commonality of these conditions caught on, one senior member at the meeting suggesting that British surgeons be canvassed for their experience of thyroidectomy. The following month the Society set up a committee, which included Semon, to investigate the whole matter. He had already advised Ord to write to Kocher, as mentioned above. Indeed, Semon’s role in the unfolding thyroid story deserves much better recognition.

The Society’s survey was a remarkable project, enlisting Europe-wide – including Russian – surgical evidence. One hundred and fifteen surgeons were contacted, including two in Australia. Sixty nine replies were received, 64 of which were usable though to a variable extent. The Committee’s very detailed findings and influential conclusions were published five years later, in 1888, as a supplement volume to the Society’s Transactions (Clinical Society of London 1888). The report fully endorsed Semon’s view, drawing particularly on animal work carried out by Victor Horsley, one of the committee’s members. Horsley had separately reported the effects of total thyroidectomy on monkeys, concluding that myxoedema was almost certainly due to loss of thyroid function and not to ‘chronic asphyxia’, as the Clinical Society’s report summarised Kocher’s explanation (Horsley 1885). He also observed initial tetanic manifestations post-operatively, no doubt due to unwitting removal or operative ischaemia of the parathyroid glands, whose separate identity and function were still unrecognised. The report’s section on treatment, however, had very little to say, surprisingly making no mention of the possibility of any kind of thyroid replacement therapy despite acknowledging that, four years earlier, Moritz Schiff in Geneva had reported some success in transplanting canine thyroid in thyroidectomised dogs (Schiff 1884). Kocher, too, had by then tried thyroid transplantation in one of his patients and would continue experimenting with this till the end of his life (Tröhler 2010b; 2010c).

Horsley went on to advocate a trial of grafting, specifically sheep’s, thyroid to treat myxoedema and cretinism (Horsley 1890). In June 1890, Bettencourt and Serrano of Lisbon did the experiment, inserting half of a sheep’s thyroid subcutaneously into the infra-mammary region on each side of one of their patients (Bettencourt and Serrano 1890; 1891). They found that the graft worked immediately, before it could have vascularised, and concluded that its effect was likely to have been due to simple absorption of juice from the grafted gland, a conclusion of extraordinary importance. They had observed a rise in temperature within 24 hours – not associated with any features suggesting a postoperative febrile reaction – and, over the course of the one month’s follow-up, the patient’s bloating and weight had decreased, bodily movement and speech had improved, sweating had resumed and there was an almost complete resolution of a preoperative anaemia. These findings, and others describing the benefits, albeit transient, of intravenous injection of thyroid extract in thyroidectomised dogs (Gley 1891; Vessale 1891), added to the growing recognition of the thyroid’s endocrine function (although the word ‘endocrine’ was not used until 1904 (Medvei 1993))

In Britain, at a meeting of the Northumberland and Durham Medical Society on 12 February 1891, George Murray, 3 years qualified, having taken advice from Horsley, who had been one of his undergraduate teachers (Paget 1919), presented his idea to treat a case of myxoedema with an extract of sheep’s thyroid given subcutaneously (Murray 1891b). He, too, Medvei (1993) tells us, was ridiculed. While the typed minutes of the meeting contain no trace of ridicule; indeed, to the contrary, what could be interpreted as cautious support, Medvei has sourced a reliable account of one senior member of the Society saying: ‘It would be just as sensible to treat a case of locomotor ataxia with an emulsion of spinal cord’. The medical college at Newcastle refused to help.

Don't you find it surprising that such a common disease seems to have been diagnosed/treated according to symptoms before the blood tests were introduced? Nowadays it all depends upon our TSH result whilst ignoring the most disabling symptoms and prescribing something else for them.

Indeed. Even more disgraceful is that reading on the forum has alerted me to the fact that many of our symptoms seem to be caused by the pharmaceutical 'solutions'.

I am not a Luddite and am most grateful for medical advances where they have been made. Why is it that some complaints have leapt into the future with their management whilst some remain the poor relations ? Would men take mare's wee if they got the 'pause ? Hmmm... Yet maybe that's not such a good example to use - at least Premarin was 'natural'. I've been for my hygenist visit at the dentist today and she lets me know that in Scandi schools, each child is gievn a xylitol ( made from tree bark ) mint to suck, after lunch, as xylitol significantly reduces plaque acid. Why haven't we heard of this ? Oh, hang on...pharma can't claim provenance of tree bark, cant they ?

No, no money to be made . By giving us the cheapest of thyroid hormones and especially if it's not at an optimum to make us feel well, they make more money for 'treating' symptoms and insisting it's nothing to do with levo.

Well xylitol is not actually made of bark. If you drill a hole to silver birch and stick pipe into that hole it starts running liquid out. That is what xylitol (in my mind )is made of.

My parents have bottles of that liquid in freezer as it is very healthy to drink anyways. It is very sweet as it is sugar but otherwise tastes just boring.

When I was young we were not given xylitol but we got toothbrush and toothpaste from school and HAD to brush our teeth after lunch. But that was not so clever either get your teeth brushed three times a day with old fashion toothpaste that was full of nasty fluoride.

But yes these days in many places you get xylitol from kindergarten to sixth grade I think.

Oh Shaws.......Where do you dig them out from? ........what a good read....thank you for that.I'm not sure what comment I could make that would be useful, other than to say I too have received minutes from meetings that made me wonder if I had been at the same meeting as the chairman and the minutes secretary.( however, they were married to each other !!!!)

What a brilliant article "Tri-iodothyronine (T3) was then identified, isolated and synthesised in 1952/53 (Gross and Pitt-Rivers), but, until relatively recently, used only in the management of myxoedema coma." Unfortunately many GPs have not moved on significantly since then.

I doubt they know what is a myxedema coma. The fact also, rarely do they test our Free T3 saying it's not necessary but considering T3 is the only active thyroid hormone and if the patient doesn't have sufficient or is Resistant (needing larger doses of T3) doctors seem to be unaware it could be helpful to the patient.

If you are on T3 only but are feeling well, I woudn't bother about 'abnormal' blood tests.

Before the blood tests along with levothyroxine were introduced, they were only for levothyroxine use as far as I am concerned.

If we use T3 only - bloods cannot correspond as we dont take T4. If we take NDT, again due to it containing T4, T3, T2, T1 and calcitonin that cannot correlate either.

So ignore blood tests - we only need 1 a year if stable, the T4 will be low or nil, the T3 will be higher.

Before the blood tests and levo were introduced we were given NDT until symptoms were gone and we felt well - I think that's they way holistic doctors would go along with as well. If symyptoms develop with either T3 or NDT, we usually need a small adjustment, either up or down. Pulse and temp can be good guides.

I would like to know how much the blood tests earn the producers of them.

Some really useful step one information about the fluctuation of tsh/t3/t4 during the day/night of perfectly healthy individuals and also the low based temperature when using t3 only as a medication. But why is is the based temperature dipping so when using t3 only as a medication?